Special prep w/ IVP for Addison's pt?????

What specific modifications need to be made when preparing a pt with Addison's disease for an IVP (intravenous pyelogram)???
I've got this question on a study guide for an upcoming comprehensive exam, and I CANNOT figure it out!!! PLEASE HELP!!!

Could it be related to renal insufficiency/failure (which would contraindicate use of contrast dye) because the adrenal glands are above the kidneys???

the amount of salt in the diet and medications, such as over-the-counter pain relievers of the non-steroid class (such as motrin and advil), diuretics (water pills), beta blockers, steroids, angiotensin-converting enzyme (ace) inhibitors, and oral contraceptives can affect the test results. some of these drugs are used to treat high blood pressure. your doctor will tell you if you should change the amount of sodium (salt) you ingest in your diet, your use of diuretics or other medications, or your exercise routine before aldosterone testing.

Addison's patients are dependent upon cortisol replacement for survival. Anytime a known stressor is added such as a medical procedure, their corticosteroid dosage should be doubled (minor stressor) or even tripled (major stressor). An IVP is not the most comfortable of procedures. Some patients report burning and/or discomfort from the dye. A patient with Addison's can not release their own cortisol in response to the stress of the medical procedure.

Unless the patient has other contraindications such as an allergy to the dye or renal insufficiency, my understanding is that you have to make adjustments to their corticosteroid dose. Perhaps those more educated in endocrine/renal issues can provide a better answer.

Dec 18, '09

If renal involvement (frequently occurs with addison's) special procedures will usually request what the GFR is. In some situations patients will not be able to utilize contrast materials which can induce acute/chronic renal failure. I have had numerous pt's on dialysis that did not have renal issues until undergoing these test. My one and only IVP put me in acute renal failure, fortunately mine was able to be resolved but I am not able to recieve contrast or dyes. I know this doesnt answer your question specifically but maybe you can locate some generalized info related. I noticed you posted this in the renal forum also. Give it some time as "traumaRUs" may be able to answer this one best as a NP in Nephrology. Maybe private message him/her?